Quiz 2 (chest xrays)

Why should chest x-rays be taken upright

So the diaphragm gets pulled down by the help of gravity. Make the diaphragm go low as possible.

What kVp is used for a chest x-ray

110-125kvp

What does pneumothorax mean

Air escaping the lungs. Air is not in the lungs for the alveoli, it’s escaping outside of the lung and that causes it to collapse.

What does pleural effusion mean

Abnormal fluid of the pleural cavity of the lungs. The lungs cannot expand fully because of the fluid.

What does hemothorax mean

Blood accumulation in the pleural cavity. It is mostly caused by car accidents and severe trauma like internal bleeding.

What is the central ray location for a PA chest

Perpendicular to the IR and it will be at T7

How can this CR location be located on the body

You feel the spine to be centered. and T7

What SID should be used

72 inches

Describe the positioning of a PA chest.

Adjusting the height of the IR to their chin area, shoulders rolled forward to hold the railings, center the CR to the T7 spine, feel the shoulders to see if it's rotated. If rotated, make sure to make it straight, and then measure the light from the acromion process and make sure it’s 1 to ½ inches. Then add your markers and tell them breathing instructions

Why should the shoulders be rolled forward

To move the scapula out of the lung field.

How much of the image receptor (IR) should be above the relaxed shoulders

1 ½ and 2 inches from acromion process.

What plane of the body is parallel to the image receptor in a properly positioned PA chest

• MCP (mid coronal plane) (front to back)

What is the proper breathing instructions and Why is it used

2nd breath inspiration to show full lung inflation at 2nd inspiration.

What anatomy should be visible on a properly positioned PA chest

Has to see 10 posterior ribs above diaphragm,

How many pairs of posterior ribs should be visible above the diaphragm

Should be 10 posterior ribs. If this is not seen, what error occurred

Which lateral chest is preferred

Left lateral to avoid magnificaiton of the heart.

What is the central ray location for a lateral chest

T7,

What SID should be used for Chest Xray

72 inches

Describe the positioning of a lateral chest.

You tel them to put their hands on the hand railings above them, move their body close to the IR, check if their back has a sliver of light, lower the IR to their height. Make sure their shoulders is perpendicular to the ir and then rotate the right shoulder a little bit forward.

What plane of the body is parallel to the IR in a properly positioned Lateral chest

MSP (mid saggital plane) (left and right)

What is the proper breathing instructions for lateral chest

2nd inspiration

How can you tell if there is rotation in your image

If the cotosphrenic angle is too close to the bottom of the image, it is slightly magnified bc the shoulders are not close to the IR.

What is the central ray location for an AP chest

T7 and 3 inches below jugular notch

How can you locate this location AP chest

You palpate it with 3 fingers to show that it is 3 inches below jugular notch

What plane of the body will be parallel with the IR if properly positioned AP chest

MCP (mid coronal plane) (front to back)

What additional information be included on your AP chest image

It’s mostly for wheelchairs and for people in stretchers.

If a 72” SID cannot be accomplished, what SID would be preferred for an AP chest

Should at least 60 SID.

If you patient is unable to sit completely upright, how would the central ray be adjusted to reduce the chance of distortion of the lungs

The tube would be angled to at least to decrease it’s vertical height

What is the breathing instructions for an AP chest

Take a deep breath in and take it as 2nd inspiration.

How long before the exposure should your patient be positioned for lateral decubitus image

Minimum of 5 minutes

If your patient suffers from pleural effusion on the right side, which lateral decubitus will be performed

Right

If your patient suffers from pneumothorax on the left side, which lateral decubitus will be performed

Right since air goes up.

What’s the first thing that needs to be done in positioning your patient for a lateral decubitus and why

Place them in a lateral decubitus sponge and let them turn to that side for 5 mins so the fluid goes down.

Describe how you will properly position for this image. for lateral decubitus

Give them a decubitus sponge and lay them on the side for 5 minutes so the fluid/air goes down. Then get their arms up after 5 minutes.

What is the central ray location

T7, MSP (3 in after jugular notch)

What is the proper breathing instructions

Inspirations. Tell them to take a breath in and out then do it again so they can absorb more oxygen.

If the patient is lying on his right side, the image receptor is placed against their chest, and the horizontal central ray is entering his back, what is the projection

PA and position is right lateral decubitus

According to the textbook, how should the above image be marked

Mark side up and annotate it side up.

What is the name of the device used to immobilize a child ages 0-3 years

Pigg-o-stat

What kVp should be used for a pediatric chest

Lower kVp than the adults. So around 89-90/

What size IR should be used for a pediatric chest

12x10

What is the central ray location for a pediatric chest

C4 for NICU, T7 toddlers.

What anatomy should be included in a pediatric AP chest

Upper respiratories

Who is the best person to hold a pediatric patient during the exposure

The family members or the mom. Make sure the mom is not pregnant.

Postanesthesia Care Unit (PACU)

Closely monitored by a nurse for some time, wear a lab apron/lab coat because they are susceptible for anything, and see how their patients progresses. (they might still have epidurals and anesthesia)

Emergency Trauma Unit

Prepare to bring the portables everywhere, clear bags to the IR and slide it to the back of the patient. The bag protects it from blood and bodily fluids. Ask the nurse what trauma it is so you can mentally prepare, keep an eye on the patient incase it’s condition might get worse (which indicates crashing), few extra led apron incase someone cant leave the room when exposing, common exams are lumbar spine

Neonatal Intensive Care Unit (NICU)

Have infections, premature babies which has warming tents, and little incubators. It’s the nurses who have to position them since they know which images we need. Wash your hands and be cautious of the oxygen and tubes. Wear a gown and gloves since they are susceptible to infections. Most common exams are chest xray. Annotate the techniques for future exams and so it can be used for other techs to keep it consistent.

Intensive Care Unit (ICU)

Extremely ill with regular care, mostly in ventilators, double check IV’s and Patient identifiers.

Coronary Care Unit (CCU)

Extremely ill with regular care, mostly in ventilators, double check IV’s and Patient identifiers.

What is the purpose of the endotracheal tube

To keep your airway open.

How far should this tube be advanced for triochostomy

5-7 cm above carina

What radiograph is taken to evaluate placement

Chest xray